Liver transplantation is an important therapeutic option for selected patients who bleed from varices. Although not appropriate for individuals with normal hepatocellular function and variceal hemorrhage (e.g., schistosomiasis and portal vein thrombosis), survival rates after transplantation are superior to all other therapies for bleeding varices in patients with advanced liver disease (Child's class C). In patients with variceal hemorrhage and good hepatic functional reserve (Child's classes A and B), sclerotherapy is the preferred initial treatment, with shunts or transplantation being reversed for sclerotherapy failures. Potential transplant candidates who have received other treatments for variceal bleeding (sclerotherapy or surgery) should be closely monitored so that they can undergo transplantation before they become prohibitive operative risks.
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